Comparison of an automated algorithm to expert physician interpretation of 80-lead body surface mapping in the evaluation of acute myocardial ischemia and infarction in patients presenting to the emergency department with chest pain: results from the Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction trial

Introduction/Background Eighty-lead (80 L) body surface map (BSM) technology provides electrocardiogram data for the clinician to interpret. A BSM device also offers an automated interpretation. Little information is available about the performance of automated algorithm interpretation in comparison to human interpretation of the 80 L BSM. Methods Interpretations of BSMs by automated algorithm and a core laboratory of physician readers from The Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction trial were compared. The κ statistic and its 95% confidence interval for concordance were calculated. The effect of BSM quality on concordance was also analyzed. Results 3405 maps for 1601 subjects were reviewed by the core laboratory and automated algorithm. There was a combined concordance rate of 87.3% ( κ = 0.46; 95% confidence interval, 0.40-0.52). A decrease in signal quality was associated with a decrease in concordance between human and automated algorithm interpretation ( κ = 0.52 for good quality vs κ = 0.30 for poor quality). Conclusion A moderate degree of concordance was noted between physician and automated algorithm interpretation of 80 L BSMs. Signal quality of 80 L electrocardiographic BSM directly affected concordance.